Case 2

Question 1

A 20-year-old patient A. was admitted to the Infectious Disease Clinic on day 2 of the disease with complaints of diffuse headache, pain in the muscles of the neck and extremities, vomiting, photophobia, irritability, and fever (39–40 °C). Epidemiological history: 10 days before the disease – a tick attached to the scalp area; specific immunoglobulin was introduced 2 days after the removal of the tick. Objective findings: pronounced rigidity of the occipital muscles, positive Kernig’s and Brudzinski’s signs, heart rate is 124 beats per minute, blood pressure is 140 / 85 mm Hg. Cerebrospinal fluid analysis: it flowed out in a stream, transparent, cytosis – 0.036 G / l (78% – lymphocytes), protein – 0.16 g / l, glucose – 2.7 mmol / l. Task 1. Make a clinical diagnosis and provide its justification.

Answer 1

severe meningeal tick-borne encephalitis.

The patient’s symptoms, epidemiological history, and cerebrospinal fluid analysis (lymphocytic pleocytosis, normal glucose levels, and slightly elevated protein levels) are consistent with TBE. The positive Kernig’s and Brudzinski’s signs, along with the patient’s high fever and headache, suggest meningeal involvement.

Question 2

Refer the patient for specific tests.

Answer 2

2. Specific tests: The patient should be tested for TBE virus antibodies in both serum and cerebrospinal fluid using enzyme-linked immunosorbent assay (ELISA) or indirect immunofluorescence assay (IFA).

Question 3

3. Make a differential diagnosis with infectious diseases with meningeal syndrome

Answer 3

bacterial meningitis (such as meningococcal meningitis),
viral meningitis (such as herpes simplex virus or enterovirus), and
fungal meningitis.

Question 4

Make a treatment plan in accordance with the current clinical recommendations / treatment protocols.

Answer 4

The patient should be hospitalized and treated with supportive care, including fluids but fluid can worsen ICP
antipyretics, and pain relief: paracetamol, NSAIDs metamizol is specific for TBEV
For vomiting: setron or chlorpromazine
For increased ICP : mannitol 1mg/kg
Or dexamethsone 10mg IV then 4mg every 6hrs
Antiviral therapy with intravenous immunoglobulin (IVIG) 0. 1 mg/kg with anti- hemagglutination 1: 160-1:320
+ interferon may also be considered. In severe cases, corticosteroids may be used to reduce inflammation. Prevention of TBE involves vaccination against the virus, which should be offered to individuals living in or traveling to endemic areas.